Lincolnshire is grappling with a demographic crisis, as the county has seen above-average growth in its population aged over 65, particularly among those over 75.

This shift, along with the ongoing impact of the pandemic, has placed unprecedented strain on mental health and dementia services in the county.

Lincolnshire currently has approximately 180,000 residents aged over 65. This number is projected to increase by 46% to 250,000 by 2041.

Within this increase, the cohort of over 75s is expected to see the most significant rise, of around 87%.

Lincolnshire already has a median age two years higher than the national average (42 years vs. 40 years).

The county also has a larger young-onset dementia population than average, higher than regional neighbours with larger overall populations.

This is attributed to the largest age cohort in Lincolnshire currently being those between 50-64 years.

These individuals represent both the key age demographic for young-onset dementia and will also contribute to a large cohort moving into the over-65 age bracket in the coming years, further exacerbating the ageing population trend.

"Lincolnshire continues to experience an above national average growth in the over 65 years population, and greater growth specifically in the over 75s," a report from the Lincolnshire Partnership NHS Foundation Trust (LPFT) told Lincolnshire County Council's Health Scrutiny Committee.

According to the LPFT report, the county is facing unique challenges in providing mental health and dementia services to its ageing population.

The report highlights that while Home Treatment Teams offer substantial support, they are not equipped to handle crisis situations for dementia patients.

Additionally, the county is working to address longer waiting times for dementia assessments by introducing digital memory assessments and additional support mechanisms.

This is particularly crucial as Lincolnshire has seen an above-average growth in its elderly population, further increasing the demand for these services.

"This, alongside the ongoing impact of the Covid-19 pandemic, has seen a continued rise in demand and referrals for both mental health services and in particular, dementia-related support," said the report.

Referrals to these services have increased by about 20% between 2020 and 2023, according to LPFT.

The trust also reports that the average waiting time for memory assessment services is around 12 weeks.

Due to the impact of the pandemic, the Trust accumulated higher than usual waits from early 2020 to mid-late 2022.

These delays, along with the growing demand related to population growth and increased awareness of dementia, have seen referrals to the services increase by about 20% between 2020 and 2023.

This has also been further impacted by staffing challenges, like all NHS organisations.

The Trust is working on recruitment and retention strategies to address these issues. But councillors have voiced concerns about the backlog and waiting times.

"We have started to look at different methods of service delivery to try and increase the modes of access to the service," said Steven Roberts, LPFT Head of Dementia Services, during the health scrutiny meeting last Wednesday.

"If we're going to try to stop the need or prevent the growing population from a mental health and dementia perspective, we really need to put the preventative work in place now," he said.

It was acknowledged that challenges in recruitment and retention are affecting service delivery. This issue is not unique to dementia services, but is prevalent across the healthcare sector.

The council inquired about opportunities to expand services to meet the needs of the growing ageing population.

Plans to optimise existing resources by collaborating with other health and social care providers and engaging with voluntary and community organisations were discussed.

The aim is to create a collaborative network of services with a "no wrong door" approach, ensuring seamless access to a full range of services.

The issue of costly respite care was raised, and the importance of making it more accessible was emphasised.

The Trust is advocating for funding to expand services and make respite care more affordable.

The tension between older people's mental health and dementia services was also highlighted.

Both functions, currently managed by the same team, have seen the prioritisation of higher acuity mental health cases.

As a result, routine dementia assessment referrals tend to accumulate.

Lincolnshire Partnership NHS Foundation Trust is actively considering separating these services to balance resources more effectively.

The Trust is also focusing on a preventative agenda, especially around dementia, to change the projected future impact.

Michael White, Regional Manager for Alzheimer's Society in South Yorkshire and Lincolnshire, highlighted that there are over 300 people under the age of 65 in Lincolnshire with 'young onset dementia,' a group with specific needs that are currently unmet by existing services.

He also stressed the importance of unpaid carers, who often lack the support they need.

He pointed out that the relatively new Integrated Care Board for Lincolnshire could be a game-changer in directing resources towards much-needed dementia services.

With a growing and ageing population facing catastrophic individual care costs, White advocates for a new approach to care that funds social care on the same basis as the NHS.

"It is clear that across Lincolnshire, people with dementia and their carers are not getting enough support and the resources available have not kept up with demand," he said.

"As well as people over 65, we know recent studies have also shown that there are over 300 people under the age of 65 years with 'young onset dementia' who have much more specific needs, for which there are currently no specific support services."

LPFT has implemented various measures, including "waiting well workers" to keep in touch with those awaiting support. However, these are short-term solutions.

"We're in the process of business planning for this year. We're actually trying to get the service to a standalone service that is proportionate to the needs of Lincolnshire," added Mr Roberts.

Tom Rose, Admiral Nurse Clinical Lead at St. Barnabas, emphasised the need for a comprehensive approach.

"This is more acute in some areas than others. In terms of health population, there is also variety across the county.

"We know that the East Coast and East Lindsey for example have a higher percentage of older people than Lincoln, and above the national average.

"We also know that areas like the coast have higher deprivation rates than the county's west.

"This brings additional challenges to service planning and provision," he said.

"There have been and continue to be many pressures on health and social care systems to meet demand. Mental health and dementia services have not always been at the top of the list of priorities nationally," Mr Rose added.

Michael White pointed out the lack of support for people with dementia and their carers.

"The current social care system is not set up properly to deliver care that meets the needs of people living with dementia.

"Decades of underfunding and neglect by successive governments have resulted in care that is costly, difficult to access, and too often not personalised to meet people's needs," he said.

"One in three people born in the UK today will get dementia — it is the UK's biggest killer," warned Michael White.

As the ageing population continues to grow, so will the demand for mental health and dementia services.

Without immediate and effective solutions, the crisis will only deepen, leaving our most vulnerable citizens at risk.

In 2019, St. Barnabas Hospice initiated the Admiral Nurse service, marking the first time Lincolnshire had access to clinical nurse specialists dedicated to families living with dementia.

Funded by public donations, the service aims to fill a gap in healthcare equity for dementia patients.

Tom Rose explained the unique challenges families living with dementia face.

"Not only do they confront an uncertain and often difficult future, but the psychological and physical impact on both the person diagnosed and their loved ones is immense," he said.

He also highlighted the importance of prevention and early diagnosis, stating that "living well with dementia means being able to access and be a part of the local community, supporting families and carers to not only care for their loved ones but also support their own well-being".